ACA Compliance | Human Resource Company
Most employers and business owners are puzzled by ACA Compliance and how it affects individual and group coverage. All health insurance plans purchased after 1st of January 2014 need to comply with the Affordable Care Act. ACA compliance is essentially that. You’re required to purchase health insurance that offers coverage for all ten essential benefits with no benefit or lifetime maximums. You must also adhere to the consumer protections kept in place by the law.
Unfortunately, implementing ACA compliance isn’t as easy as it sounds. The rules and regulations are complex and not easy to understand so figuring out how to comply with all the terms can be problematic. That’s why you need an expert that’s familiar with the system.
ACA Compliance in Brief
As mentioned before, the new health insurance policy needs to cover ten essential health benefits that have no annual or lifetime maximums. These two concepts are explained in brief below:
Ten Essential Health Benefits: According to statistics, only about 2% of the total health insurance plans would cover the following benefits, which only lead to more expense for the individual. Needs like maternity, substance abuse, mental illness, rehabilitation, prescription drugs, etc, were not covered in some plans. From 2014, the following health benefits should be included in all plans:
- Maternity Care and Newborn Care
- Emergency Services
- Prescription Drugs
- Ambulatory Services
- Lab Tests
- Chronic Disease Management, including preventive screenings
- Pediatric Services, including vision and dental problems
- Rehabilitative Services
- Mental Health problems and Substance Abuse Problems
For ACA compliance, the health insurance policy must cover all of these. These include both, on and off-exchange plans.
The Lifetime Maximum Benefit
Before this ACA was implemented, health insurance companies could set a limit to how much amount a plan would pay the insured during his or her lifetime. This means that the plans set a cap on how much the health insurance would pay during a person’s lifetime’ if a person surpassed that limit, he or she won’t get any more insurance cover.
That has been removed as well. For ACA compliance, health insurance can’t set a cap on the amount spent on the ten essential health benefits mentioned above. This means that the insured individuals have no limit to coverage on essential health benefits.
Another factor of ACA is that the health insurance is a guaranteed issue; any pre-existing health problems aren’t really considered when the coverage is offered. So anyone regardless of their age or health is eligible to get health insurance coverage.
ACA Compliance Checklist
There are several ways you can ensure that you are complying with the ACA and offering the required health insurance to your employees. Here are some things you need to keep in mind:
- Employees and dependents need to be provided minimum essential coverage that’s affordable and offers minimum value at the very least.
- Employers need to file forms with the IRS that includes all information about ACA compliance.
There are several other aspects involved in ACA compliance, which is why it’s a good idea to hire a consultant to guide you through the process.
Content by Webvisable